=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750037206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EUGENE DENTAL PARTNERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2022
-----------------------------------------------------
Last Update Date | 02/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2457 OAKMONT WAY
-----------------------------------------------------
City | EUGENE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97401-6460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-484-2046
-----------------------------------------------------
Fax | 541-683-5333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1640 G ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97477-4226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-484-2046
-----------------------------------------------------
Fax | 541-683-5333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MATTHEW MCLAUGHLIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-484-2046
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------